Provider Demographics
NPI:1124807268
Name:DUQUETTE, LAUREN (RDN, LDN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DUQUETTE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 GRANDOVER VILLAGE RD APT 304
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7392
Mailing Address - Country:US
Mailing Address - Phone:949-606-2875
Mailing Address - Fax:
Practice Address - Street 1:500 PINEVIEW DR STE 205
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3814
Practice Address - Country:US
Practice Address - Phone:336-329-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered